Dealing with dental insurance

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Dealing with dental insurance
2006
Roger Levin, DDS, MBA
Journal of the American Dental Association

Dental insurance is a complex issue for many dental practices. Owing to the number of plans, contract variations, predetermination procedures and patient questions, dental insurance can use up a great deal of administrative time in a practice.

For many practices, it has become virtually impossible to keep up with all the plans and changes, making it a daily challenge to provide proper information and customer service to patients. However, a few procedural changes can correct this problem.

EXPLAINING DENTAL INSURANCE

Educate all patients about their insurance focusing on the five or six key factors of insurance. Because patients are concerned with out-of-pocket expenses, you might include information such as maximum allowable benefits, percentage of coverage for varying services, predetermination factors, filing of insurance, copayments, covered and non-covered services.

If all current and new patients were educated and if they knew the answers to the five or six frequently asked questions about dental insurance, then the amount of time needed to discuss dental insurance with them would be reduced dramatically. It is not simply a matter of reducing it by minutes or hours, but literally by days. This "found" time could be spent productively on other front desk–related activities over the course of a year.

If all current and new patients were educated about dental insurance, then the amount of time needed to discuss dental insurance with them would be reduced dramatically.

DENTAL INSURANCE AND CASE PRESENTATION

The next step that may benefit many practices is to be sure that a patient not only understands the basics of his or her plan, but also how these factors link to treatment options you may be presenting. Many treatment plans are rejected in the later stages of discussion when the patient realizes dental insurance will not cover certain procedures such as esthetic or implant dentistry (a few plans cover these, but not many).

When patients suddenly find out that there will be a significant copayment or no insurance coverage at all, they may become unable to make a decision, thus bringing the process of accepting treatment to a grinding halt. At that point, they have to decide whether they have sufficient funds and whether it is worth performing the procedure based on the amount of the copayment.

My suggestion is that explanations about dental insurance (especially copayments, noncovered and covered services) and the office’s policy regarding these issues take place either before or early in the treatment presentation process. This will allow the dentist to overcome the obstacle of dental insurance issues while recommending to a patient excellent need-based treatment or potential elective treatment.

SUMMARY

I suggest that dental practices tightly manage dental insurance. Practices should inquire if they need to submit a predetermination for services and whether the lack of a predetermination will result in a claim denial. Even though the insurer does not necessarily require it, many practices simply submit predeterminations as a routine. Patients often advise the office if they want to go ahead with treatment regardless of what the insurance company will pay, as long as they are provided an explanation in advance about responsibility for payment. This approach can save a tremendous amount of time and ensure that the patient receives treatment instead of losing motivation during the predetermination phase.

If predeterminations are required, it is best to bring the patient back to the office and review the proposed case presentation and financial arrangements once it arrives. For larger cases, a practice may want to have the patient return for an additional and a final consultation to help him or her gain a new sense of motivation and interest in having the necessary treatment.

Dental insurance companies can have many different policies, with varying requirements depending on the company. This requires a tremendous amount of time on the part of dentists and their office teams to communicate with insurance companies, file all the proper data, acquire predetermination information when required and address a myriad of other factors. By managing this process carefully, practices can save time and labor expenses, especially if patients are well-educated regarding what their dental insurance covers and what it does not.